<?php
function date_dropdown($year_limit = 0){
$html_output = '    <div for="Current" accesskey="CUR" id="date_select" >'."\n";
$html_output .= '        <label for="date_day">Date of birth:</label>'."\n";

/*days*/
$html_output .= '           <select name="date_day" id="day_select" style="width:150px;">'."\n";
for ($day = 1; $day <= 31; $day++) {
$html_output .= '               <option>' . $day . '</option>'."\n";
 }
$html_output .= '           </select>'."\n";
	 
/*months*/
 $html_output .= '           <select name="date_month" id="month_select" style="width:150px;" >'."\n";
$months = array("", "January", "February", "March", "April", "May", "June", "July", "August", "September", "October", "November", "December");
for ($month = 1; $month <= 12; $month++) {
$html_output .= '               <option value="' . $month . '">' . $months[$month] . '</option>'."\n";
}
 $html_output .= '           </select>'."\n";
	 
/*years*/
 $html_output .= '           <select name="date_year" id="year_select" style="width:150px;">'."\n";
for ($year = 1900; $year <= (date("Y") - $year_limit); $year++) {
$html_output .= '               <option>' . $year . '</option>'."\n";
 }
 $html_output .= '           </select>'."\n";

 $html_output .= '   </div>'."\n";
 return $html_output;
}
?>
<div class="main-content-block html5-contact-form">
	<section id="contact">
		<mark id="message"></mark><br>
        
     


		<form method="post" action="classes/contact.php" name="contactform" id="contactform" autocomplete="on">

			<fieldset>

				<legend>Contact Details</legend>

				<div>
					<label for="name" accesskey="U">Your Name</label> <!--<table  ><tr><td>-->
					<input name="name" type="text" id="name" style="width:150px;" placeholder="First Name" required />
                    <input name="name" type="text" id="name" style="width:150px;" placeholder="Middle Name" required />
                    <input name="name" type="text" id="name" style="width:150px;" placeholder="Last Name" required /><!--</td></tr></table>-->
				</div>
                <div>
					<label for="gender" accesskey="GNDR">Gender</label>
                    <select name="gender" id="gender" required="required">
						<option value="N/A"> </option>
						<option value="Male">Male</option>
						<option value="Female">Female</option>
					</select>					 
				</div>
				
                <div>
					<label for="Nationality" accesskey="NAT">Nationality</label>
                    <select name="Nationality" id="Nationality" required="required">
						<option value="N/A"> </option>
                        <option value="afghan">Afghan</option>
                        <option value="albanian">Albanian</option>
                        <option value="algerian">Algerian</option>
                        <option value="american">American</option>
                        <option value="andorran">Andorran</option>
                        <option value="angolan">Angolan</option>
                        <option value="antiguans">Antiguans</option>
                        <option value="argentinean">Argentinean</option>
                        <option value="armenian">Armenian</option>
                        <option value="australian">Australian</option>
                        <option value="austrian">Austrian</option>
                        <option value="azerbaijani">Azerbaijani</option>
                        <option value="bahamian">Bahamian</option>
                        <option value="bahraini">Bahraini</option>
                        <option value="bangladeshi">Bangladeshi</option>
                        <option value="barbadian">Barbadian</option>
                        <option value="barbudans">Barbudans</option>
                        <option value="batswana">Batswana</option>
                        <option value="belarusian">Belarusian</option>
                        <option value="belgian">Belgian</option>
                        <option value="belizean">Belizean</option>
                        <option value="beninese">Beninese</option>
                        <option value="bhutanese">Bhutanese</option>
                        <option value="bolivian">Bolivian</option>
                        <option value="bosnian">Bosnian</option>
                        <option value="brazilian">Brazilian</option>
                        <option value="british">British</option>
                        <option value="bruneian">Bruneian</option>
                        <option value="bulgarian">Bulgarian</option>
                        <option value="burkinabe">Burkinabe</option>
                        <option value="burmese">Burmese</option>
                        <option value="burundian">Burundian</option>
                        <option value="cambodian">Cambodian</option>
                        <option value="cameroonian">Cameroonian</option>
                        <option value="canadian">Canadian</option>
                        <option value="cape verdean">Cape Verdean</option>
                        <option value="central african">Central African</option>
                        <option value="chadian">Chadian</option>
                        <option value="chilean">Chilean</option>
                        <option value="chinese">Chinese</option>
                        <option value="colombian">Colombian</option>
                        <option value="comoran">Comoran</option>
                        <option value="congolese">Congolese</option>
                        <option value="costa rican">Costa Rican</option>
                        <option value="croatian">Croatian</option>
                        <option value="cuban">Cuban</option>
                        <option value="cypriot">Cypriot</option>
                        <option value="czech">Czech</option>
                        <option value="danish">Danish</option>
                        <option value="djibouti">Djibouti</option>
                        <option value="dominican">Dominican</option>
                        <option value="dutch">Dutch</option>
                        <option value="east timorese">East Timorese</option>
                        <option value="ecuadorean">Ecuadorean</option>
                        <option value="egyptian">Egyptian</option>
                        <option value="emirian">Emirian</option>
                        <option value="equatorial guinean">Equatorial Guinean</option>
                        <option value="eritrean">Eritrean</option>
                        <option value="estonian">Estonian</option>
                        <option value="ethiopian">Ethiopian</option>
                        <option value="fijian">Fijian</option>
                        <option value="filipino">Filipino</option>
                        <option value="finnish">Finnish</option>
                        <option value="french">French</option>
                        <option value="gabonese">Gabonese</option>
                        <option value="gambian">Gambian</option>
                        <option value="georgian">Georgian</option>
                        <option value="german">German</option>
                        <option value="ghanaian">Ghanaian</option>
                        <option value="greek">Greek</option>
                        <option value="grenadian">Grenadian</option>
                        <option value="guatemalan">Guatemalan</option>
                        <option value="guinea-bissauan">Guinea-Bissauan</option>
                        <option value="guinean">Guinean</option>
                        <option value="guyanese">Guyanese</option>
                        <option value="haitian">Haitian</option>
                        <option value="herzegovinian">Herzegovinian</option>
                        <option value="honduran">Honduran</option>
                        <option value="hungarian">Hungarian</option>
                        <option value="icelander">Icelander</option>
                        <option value="indian">Indian</option>
                        <option value="indonesian">Indonesian</option>
                        <option value="iranian">Iranian</option>
                        <option value="iraqi">Iraqi</option>
                        <option value="irish">Irish</option> 
                        <option value="italian">Italian</option>
                        <option value="ivorian">Ivorian</option>
                        <option value="jamaican">Jamaican</option>
                        <option value="japanese">Japanese</option>
                        <option value="jordanian">Jordanian</option>
                        <option value="kazakhstani">Kazakhstani</option>
                        <option value="kenyan">Kenyan</option>
                        <option value="kittian and nevisian">Kittian and Nevisian</option>
                        <option value="kuwaiti">Kuwaiti</option>
                        <option value="kyrgyz">Kyrgyz</option>
                        <option value="laotian">Laotian</option>
                        <option value="latvian">Latvian</option>
                        <option value="lebanese">Lebanese</option>
                        <option value="liberian">Liberian</option>
                        <option value="libyan">Libyan</option>
                        <option value="liechtensteiner">Liechtensteiner</option>
                        <option value="lithuanian">Lithuanian</option>
                        <option value="luxembourger">Luxembourger</option>
                        <option value="macedonian">Macedonian</option>
                        <option value="malagasy">Malagasy</option>
                        <option value="malawian">Malawian</option>
                        <option value="malaysian">Malaysian</option>
                        <option value="maldivan">Maldivan</option>
                        <option value="malian">Malian</option>
                        <option value="maltese">Maltese</option>
                        <option value="marshallese">Marshallese</option>
                        <option value="mauritanian">Mauritanian</option>
                        <option value="mauritian">Mauritian</option>
                        <option value="mexican">Mexican</option>
                        <option value="micronesian">Micronesian</option>
                        <option value="moldovan">Moldovan</option>
                        <option value="monacan">Monacan</option>
                        <option value="mongolian">Mongolian</option>
                        <option value="moroccan">Moroccan</option>
                        <option value="mosotho">Mosotho</option>
                        <option value="motswana">Motswana</option>
                        <option value="mozambican">Mozambican</option>
                        <option value="namibian">Namibian</option>
                        <option value="nauruan">Nauruan</option>
                        <option value="nepalese">Nepalese</option>
                        <option value="new zealander">New Zealander</option>
                        <option value="ni-vanuatu">Ni-Vanuatu</option>
                        <option value="nicaraguan">Nicaraguan</option>
                        <option value="nigerien">Nigerien</option>
                        <option value="north korean">North Korean</option>
                        <option value="northern irish">Northern Irish</option>
                        <option value="norwegian">Norwegian</option>
                        <option value="omani">Omani</option>
                        <option value="pakistani">Pakistani</option>
                        <option value="palauan">Palauan</option>
                        <option value="palestinian">palestinian</option>
                        <option value="panamanian">Panamanian</option>
                        <option value="papua new guinean">Papua New Guinean</option>
                        <option value="paraguayan">Paraguayan</option>
                        <option value="peruvian">Peruvian</option>
                        <option value="polish">Polish</option>
                        <option value="portuguese">Portuguese</option>
                        <option value="qatari">Qatari</option>
                        <option value="romanian">Romanian</option>
                        <option value="russian">Russian</option>
                        <option value="rwandan">Rwandan</option>
                        <option value="saint lucian">Saint Lucian</option>
                        <option value="salvadoran">Salvadoran</option>
                        <option value="samoan">Samoan</option>
                        <option value="san marinese">San Marinese</option>
                        <option value="sao tomean">Sao Tomean</option>
                        <option value="saudi">Saudi</option>
                        <option value="scottish">Scottish</option>
                        <option value="senegalese">Senegalese</option>
                        <option value="serbian">Serbian</option>
                        <option value="seychellois">Seychellois</option>
                        <option value="sierra leonean">Sierra Leonean</option>
                        <option value="singaporean">Singaporean</option>
                        <option value="slovakian">Slovakian</option>
                        <option value="slovenian">Slovenian</option>
                        <option value="solomon islander">Solomon Islander</option>
                        <option value="somali">Somali</option>
                        <option value="south african">South African</option>
                        <option value="south korean">South Korean</option>
                        <option value="spanish">Spanish</option>
                        <option value="sri lankan">Sri Lankan</option>
                        <option value="sudanese">Sudanese</option>
                        <option value="surinamer">Surinamer</option>
                        <option value="swazi">Swazi</option>
                        <option value="swedish">Swedish</option>
                        <option value="swiss">Swiss</option>
                        <option value="syrian">Syrian</option>
                        <option value="taiwanese">Taiwanese</option>
                        <option value="tajik">Tajik</option>
                        <option value="tanzanian">Tanzanian</option>
                        <option value="thai">Thai</option>
                        <option value="togolese">Togolese</option>
                        <option value="tongan">Tongan</option>
                        <option value="trinidadian or tobagonian">Trinidadian or Tobagonian</option>
                        <option value="tunisian">Tunisian</option>
                        <option value="turkish">Turkish</option>
                        <option value="tuvaluan">Tuvaluan</option>
                        <option value="ugandan">Ugandan</option>
                        <option value="ukrainian">Ukrainian</option>
                        <option value="uruguayan">Uruguayan</option>
                        <option value="uzbekistani">Uzbekistani</option>
                        <option value="venezuelan">Venezuelan</option>
                        <option value="vietnamese">Vietnamese</option>
                        <option value="welsh">Welsh</option>
                        <option value="yemenite">Yemenite</option>
                        <option value="zambian">Zambian</option>
                        <option value="zimbabwean">Zimbabwean</option> 
					</select>
				</div>
                
                <div>
					<label for="CurCountry" accesskey="CUR">Country of current residence</label>
                    <select name="CurCountry" id="CurCountry" required="required">
						<option value="N/A"> </option>
                        <option value="Afghanistan">Afghanistan</option>
                        <option value="Åland Islands">Åland Islands</option>
                        <option value="Albania">Albania</option>
                        <option value="Algeria">Algeria</option>
                        <option value="American Samoa">American Samoa</option>
                        <option value="Andorra">Andorra</option>
                        <option value="Angola">Angola</option>
                        <option value="Anguilla">Anguilla</option>
                        <option value="Antarctica">Antarctica</option>
                        <option value="Antigua and Barbuda">Antigua and Barbuda</option>
                        <option value="Argentina">Argentina</option>
                        <option value="Armenia">Armenia</option>
                        <option value="Aruba">Aruba</option>
                        <option value="Australia">Australia</option>
                        <option value="Austria">Austria</option>
                        <option value="Azerbaijan">Azerbaijan</option>
                        <option value="Bahamas">Bahamas</option>
                        <option value="Bahrain">Bahrain</option>
                        <option value="Bangladesh">Bangladesh</option>
                        <option value="Barbados">Barbados</option>
                        <option value="Belarus">Belarus</option>
                        <option value="Belgium">Belgium</option>
                        <option value="Belize">Belize</option>
                        <option value="Benin">Benin</option>
                        <option value="Bermuda">Bermuda</option>
                        <option value="Bhutan">Bhutan</option>
                        <option value="Bolivia">Bolivia</option>
                        <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
                        <option value="Botswana">Botswana</option>
                        <option value="Bouvet Island">Bouvet Island</option>
                        <option value="Brazil">Brazil</option>
                        <option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
                        <option value="Brunei Darussalam">Brunei Darussalam</option>
                        <option value="Bulgaria">Bulgaria</option>
                        <option value="Burkina Faso">Burkina Faso</option>
                        <option value="Burundi">Burundi</option>
                        <option value="Cambodia">Cambodia</option>
                        <option value="Cameroon">Cameroon</option>
                        <option value="Canada">Canada</option>
                        <option value="Cape Verde">Cape Verde</option>
                        <option value="Cayman Islands">Cayman Islands</option>
                        <option value="Central African Republic">Central African Republic</option>
                        <option value="Chad">Chad</option>
                        <option value="Chile">Chile</option>
                        <option value="China">China</option>
                        <option value="Christmas Island">Christmas Island</option>
                        <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
                        <option value="Colombia">Colombia</option>
                        <option value="Comoros">Comoros</option>
                        <option value="Congo">Congo</option>
                        <option value="Congo, The Democratic Republic of The">Congo, The Democratic Republic of The</option>
                        <option value="Cook Islands">Cook Islands</option>
                        <option value="Costa Rica">Costa Rica</option>
                        <option value="Cote D'ivoire">Cote D'ivoire</option>
                        <option value="Croatia">Croatia</option>
                        <option value="Cuba">Cuba</option>
                        <option value="Cyprus">Cyprus</option>
                        <option value="Czech Republic">Czech Republic</option>
                        <option value="Denmark">Denmark</option>
                        <option value="Djibouti">Djibouti</option>
                        <option value="Dominica">Dominica</option>
                        <option value="Dominican Republic">Dominican Republic</option>
                        <option value="Ecuador">Ecuador</option>
                        <option value="Egypt">Egypt</option>
                        <option value="El Salvador">El Salvador</option>
                        <option value="Equatorial Guinea">Equatorial Guinea</option>
                        <option value="Eritrea">Eritrea</option>
                        <option value="Estonia">Estonia</option>
                        <option value="Ethiopia">Ethiopia</option>
                        <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
                        <option value="Faroe Islands">Faroe Islands</option>
                        <option value="Fiji">Fiji</option>
                        <option value="Finland">Finland</option>
                        <option value="France">France</option>
                        <option value="French Guiana">French Guiana</option>
                        <option value="French Polynesia">French Polynesia</option>
                        <option value="French Southern Territories">French Southern Territories</option>
                        <option value="Gabon">Gabon</option>
                        <option value="Gambia">Gambia</option>
                        <option value="Georgia">Georgia</option>
                        <option value="Germany">Germany</option>
                        <option value="Ghana">Ghana</option>
                        <option value="Gibraltar">Gibraltar</option>
                        <option value="Greece">Greece</option>
                        <option value="Greenland">Greenland</option>
                        <option value="Grenada">Grenada</option>
                        <option value="Guadeloupe">Guadeloupe</option>
                        <option value="Guam">Guam</option>
                        <option value="Guatemala">Guatemala</option>
                        <option value="Guernsey">Guernsey</option>
                        <option value="Guinea">Guinea</option>
                        <option value="Guinea-bissau">Guinea-bissau</option>
                        <option value="Guyana">Guyana</option>
                        <option value="Haiti">Haiti</option>
                        <option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands</option>
                        <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
                        <option value="Honduras">Honduras</option>
                        <option value="Hong Kong">Hong Kong</option>
                        <option value="Hungary">Hungary</option>
                        <option value="Iceland">Iceland</option>
                        <option value="India">India</option>
                        <option value="Indonesia">Indonesia</option>
                        <option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
                        <option value="Iraq">Iraq</option>
                        <option value="Ireland">Ireland</option>
                        <option value="Isle of Man">Isle of Man</option>
                        <option value="Israel">Israel</option>
                        <option value="Italy">Italy</option>
                        <option value="Jamaica">Jamaica</option>
                        <option value="Japan">Japan</option>
                        <option value="Jersey">Jersey</option>
                        <option value="Jordan">Jordan</option>
                        <option value="Kazakhstan">Kazakhstan</option>
                        <option value="Kenya">Kenya</option>
                        <option value="Kiribati">Kiribati</option>
                        <option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
                        <option value="Korea, Republic of">Korea, Republic of</option>
                        <option value="Kuwait">Kuwait</option>
                        <option value="Kyrgyzstan">Kyrgyzstan</option>
                        <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
                        <option value="Latvia">Latvia</option>
                        <option value="Lebanon">Lebanon</option>
                        <option value="Lesotho">Lesotho</option>
                        <option value="Liberia">Liberia</option>
                        <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option>
                        <option value="Liechtenstein">Liechtenstein</option>
                        <option value="Lithuania">Lithuania</option>
                        <option value="Luxembourg">Luxembourg</option>
                        <option value="Macao">Macao</option>
                        <option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former Yugoslav Republic of</option>
                        <option value="Madagascar">Madagascar</option>
                        <option value="Malawi">Malawi</option>
                        <option value="Malaysia">Malaysia</option>
                        <option value="Maldives">Maldives</option>
                        <option value="Mali">Mali</option>
                        <option value="Malta">Malta</option>
                        <option value="Marshall Islands">Marshall Islands</option>
                        <option value="Martinique">Martinique</option>
                        <option value="Mauritania">Mauritania</option>
                        <option value="Mauritius">Mauritius</option>
                        <option value="Mayotte">Mayotte</option>
                        <option value="Mexico">Mexico</option>
                        <option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
                        <option value="Moldova, Republic of">Moldova, Republic of</option>
                        <option value="Monaco">Monaco</option>
                        <option value="Mongolia">Mongolia</option>
                        <option value="Montenegro">Montenegro</option>
                        <option value="Montserrat">Montserrat</option>
                        <option value="Morocco">Morocco</option>
                        <option value="Mozambique">Mozambique</option>
                        <option value="Myanmar">Myanmar</option>
                        <option value="Namibia">Namibia</option>
                        <option value="Nauru">Nauru</option>
                        <option value="Nepal">Nepal</option>
                        <option value="Netherlands">Netherlands</option>
                        <option value="Netherlands Antilles">Netherlands Antilles</option>
                        <option value="New Caledonia">New Caledonia</option>
                        <option value="New Zealand">New Zealand</option>
                        <option value="Nicaragua">Nicaragua</option>
                        <option value="Niger">Niger</option>
                        <option value="Nigeria">Nigeria</option>
                        <option value="Niue">Niue</option>
                        <option value="Norfolk Island">Norfolk Island</option>
                        <option value="Northern Mariana Islands">Northern Mariana Islands</option>
                        <option value="Norway">Norway</option>
                        <option value="Oman">Oman</option>
                        <option value="Pakistan">Pakistan</option>
                        <option value="Palau">Palau</option>
                        <option value="Palestine">Palestine</option>
                        <option value="Panama">Panama</option>
                        <option value="Papua New Guinea">Papua New Guinea</option>
                        <option value="Paraguay">Paraguay</option>
                        <option value="Peru">Peru</option>
                        <option value="Philippines">Philippines</option>
                        <option value="Pitcairn">Pitcairn</option>
                        <option value="Poland">Poland</option>
                        <option value="Portugal">Portugal</option>
                        <option value="Puerto Rico">Puerto Rico</option>
                        <option value="Qatar">Qatar</option>
                        <option value="Reunion">Reunion</option>
                        <option value="Romania">Romania</option>
                        <option value="Russian Federation">Russian Federation</option>
                        <option value="Rwanda">Rwanda</option>
                        <option value="Saint Helena">Saint Helena</option>
                        <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
                        <option value="Saint Lucia">Saint Lucia</option>
                        <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
                        <option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines</option>
                        <option value="Samoa">Samoa</option>
                        <option value="San Marino">San Marino</option>
                        <option value="Sao Tome and Principe">Sao Tome and Principe</option>
                        <option value="Saudi Arabia">Saudi Arabia</option>
                        <option value="Senegal">Senegal</option>
                        <option value="Serbia">Serbia</option>
                        <option value="Seychelles">Seychelles</option>
                        <option value="Sierra Leone">Sierra Leone</option>
                        <option value="Singapore">Singapore</option>
                        <option value="Slovakia">Slovakia</option>
                        <option value="Slovenia">Slovenia</option>
                        <option value="Solomon Islands">Solomon Islands</option>
                        <option value="Somalia">Somalia</option>
                        <option value="South Africa">South Africa</option>
                        <option value="South Georgia and The South Sandwich Islands">South Georgia and The South Sandwich Islands</option>
                        <option value="Spain">Spain</option>
                        <option value="Sri Lanka">Sri Lanka</option>
                        <option value="Sudan">Sudan</option>
                        <option value="Suriname">Suriname</option>
                        <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
                        <option value="Swaziland">Swaziland</option>
                        <option value="Sweden">Sweden</option>
                        <option value="Switzerland">Switzerland</option>
                        <option value="Syrian Arab Republic">Syrian Arab Republic</option>
                        <option value="Taiwan, Province of China">Taiwan, Province of China</option>
                        <option value="Tajikistan">Tajikistan</option>
                        <option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
                        <option value="Thailand">Thailand</option>
                        <option value="Timor-leste">Timor-leste</option>
                        <option value="Togo">Togo</option>
                        <option value="Tokelau">Tokelau</option>
                        <option value="Tonga">Tonga</option>
                        <option value="Trinidad and Tobago">Trinidad and Tobago</option>
                        <option value="Tunisia">Tunisia</option>
                        <option value="Turkey">Turkey</option>
                        <option value="Turkmenistan">Turkmenistan</option>
                        <option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
                        <option value="Tuvalu">Tuvalu</option>
                        <option value="Uganda">Uganda</option>
                        <option value="Ukraine">Ukraine</option>
                        <option value="United Arab Emirates">United Arab Emirates</option>
                        <option value="United Kingdom">United Kingdom</option>
                        <option value="United States">United States</option>
                        <option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
                        <option value="Uruguay">Uruguay</option>
                        <option value="Uzbekistan">Uzbekistan</option>
                        <option value="Vanuatu">Vanuatu</option>
                        <option value="Venezuela">Venezuela</option>
                        <option value="Viet Nam">Viet Nam</option>
                        <option value="Virgin Islands, British">Virgin Islands, British</option>
                        <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
                        <option value="Wallis and Futuna">Wallis and Futuna</option>
                        <option value="Western Sahara">Western Sahara</option>
                        <option value="Yemen">Yemen</option>
                        <option value="Zambia">Zambia</option>
                        <option value="Zimbabwe">Zimbabwe</option>
					</select>
				</div>
                
                <div>
                    <?php echo date_dropdown(15); ?>
				</div>
                
                <div>
					<label for="VisaStatus" accesskey="VISA">Visa Status</label>
                    <select name="VisaStatus" id="VisaStatus" required="required">
						<option value="N/A"> </option>
						<option value="Transferable">Transferable</option>
						<option value="Non-Transferable">Non-Transferable</option>
                        <option value="Tourist">Tourist</option>
					</select>					 
				</div>
                
                <div>
					<label for="MaritalStatus" accesskey="MS">Marital Status</label>
                    <select name="MaritalStatus" id="MaritalStatus" required="required">
						<option value="N/A"> </option>
						<option value="Single">Single</option>
						<option value="Married ">Married </option>
					</select>					 
				</div>
                
                <div>
					<label for="DrivingLicense" accesskey="MS">Driving License</label>
                    <select name="DrivingLicense" id="DrivingLicense" required="required">
						<option value="N/A"> </option>
						<option value="Yes">Yes</option>
						<option value="No">No</option>
					</select>					 
				</div>
                
                <div>
					<label for="email" accesskey="E">Email</label>
					<input name="email" type="email" id="email" placeholder="Enter your Email Address" pattern="^[A-Za-z0-9](([_\.\-]?[a-zA-Z0-9]+)*)@([A-Za-z0-9]+)(([\.\-]?[a-zA-Z0-9]+)*)\.([A-Za-z]{2,})$" required />
				</div>

				<div>
					<label for="Mobile1" accesskey="P">Mobile 1</label>
					<input name="Mobile1" type="tel" id="Mobile1" size="30" placeholder="Enter your Primary Mobile number" required  />
				</div>
                
                <div>
					<label for="Mobile2" accesskey="P">Mobile 2 <small>(optional)</small></label>
					<input name="Mobile2" type="tel" id="Mobile2" size="30" placeholder="Enter your Secondry Mobile number" required  />
				</div>
                
                <div>
					<label for="phone" accesskey="P">Home <small>(optional)</small></label>
					<input name="phone" type="tel" id="phone" size="30" placeholder="Enter your Home number" required  />
				</div>

				 

			</fieldset>

			<fieldset>

				<legend>Languages</legend>

				<div>
					<label for="LangEN" accesskey="LANGE">English</label><small>(Speak/Write/Read)</small>
                    <select name="LangEN" id="LangEN" required="required">
						<option value="N/A"> </option>
						<option value="0">I Dont Know this Language</option>
						<option value="Average">Average</option>
                        <option value="Good">Good</option>
                        <option value="Fluent">Fluent</option>
					</select>					 
				</div>
                
                <div>
					<label for="LangAR" accesskey="LANGA">Arabic</label><small>(Speak/Write/Read)</small>
                    <select name="LangAR" id="LangAR" required="required">
						<option value="N/A"> </option>
						<option value="0">I Dont Know this Language</option>
						<option value="Average">Average</option>
                        <option value="Good">Good</option>
                        <option value="Fluent">Fluent</option>
					</select>					 
				</div>
                
				
				<div>
					<label for="Other" accesskey="C">Other</label>
					<textarea name="comments" cols="40" rows="3" id="comments" placeholder="Please Specify All Languages You know" spellcheck="true" required></textarea>
				</div>

				 
			</fieldset>
            
            
			<fieldset>

				<legend>Qualifications and Experiences</legend>

				<div>
					<label for="Certification" accesskey="CERT">Last Achieved Certification</label></small>
                    <select name="Certification" id="Certification" required="required">
						<option value="N/A"> </option>
						<option value="HighSchool">High School or equivalent</option>
						<option value="Diploma">Diploma</option>
                        <option value="Bachelors">Bachelors </option>
                        <option value="Masters">Masters</option>
                        <option value="Doctorate">Doctorate</option>
                        <option value="other">Other</option>
					</select>	
                    <input name="o-Certification" type="text" id="o-Certification" style="width:150px;" placeholder="If Other Please Specify" required />
                    
                    				 
				</div>
                
                <div>
					<label for="YearEx" accesskey="YOE">Years of Experience</label></small>
                    <select name="YearEx" id="YearEx" required="required">
						<option value="N/A"> </option>
                        <option value="0">Entry Level</option>
                        <option value="1">1 Year</option>
                        <?php 
						for($i=2;$i<90;$i++)
						echo '<option value="'.$i.'">'.$i.' Years</option>';
						
						?>
						
					</select>	
                
				<div>
                
                <div>
					<label for="WorkSector" accesskey="YOE">Current Work Sector</label></small>
                    <table id="checkbox-form">
                    	<tr>
                        	<td ><input name="WorkSector" type="checkbox" value="Agriculture" />Agriculture </td>
                            <td><input name="WorkSector" type="checkbox" value="Logistics" />Logistics</td>
                            <td><input name="WorkSector" type="checkbox" value="Financial-Services" />Financial Services</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Accounting-Finance" />Accounting /Finance</td>
                            <td><input name="WorkSector" type="checkbox" value="Manufacturing" />Manufacturing</td>
                            <td><input name="WorkSector" type="checkbox" value="Food and Beverage" />Food and Beverage</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Advertising" />Advertising</td>
                            <td><input name="WorkSector" type="checkbox" value="Media" />Media</td>
                            <td><input name="WorkSector" type="checkbox" value="Retail" />Retail</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Airlines/Travel" />Airlines/Travel</td>
                            <td><input name="WorkSector" type="checkbox" value="Marketing" />Marketing</td>
                            <td><input name="WorkSector" type="checkbox" value="Real-estate" />Real estate</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Automotive" />Automotive</td>
                            <td><input name="WorkSector" type="checkbox" value="Music" />Music</td>
                            <td><input name="WorkSector" type="checkbox" value="Sales" />Sales</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Banking" />Banking</td>
                            <td><input name="WorkSector" type="checkbox" value="Newspapers-Magazines" />Newspapers/Magazines</td>
                            <td><input name="WorkSector" type="checkbox" value="Security" />Security</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Customer-Service" />Customer Service</td>
                            <td><input name="WorkSector" type="checkbox" value="Pharmaceuticals" />Pharmaceuticals</td>
                            <td><input name="WorkSector" type="checkbox" value="Secretarial" />Secretarial</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Construction" />Construction</td>
                            <td><input name="WorkSector" type="checkbox" value="Information" />Information</td>
                            <td><input name="WorkSector" type="checkbox" value="Sports" />Sports</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Health-Care" />Health Care</td>
                            <td><input name="WorkSector" type="checkbox" value="Technology" />Technology</td>
                            <td><input name="WorkSector" type="checkbox" value="Telecommunication" />Telecommunication</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Hospitality" />Hospitality</td>
                            <td><input name="WorkSector" type="checkbox" value="Consultancy" />Consultancy</td>
                            <td><input name="WorkSector" type="checkbox" value="Television" />Television </td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Human-Resources" />Human Resources</td>
                            <td><input name="WorkSector" type="checkbox" value="Oil-and-Gas" />Oil and Gas</td>
                            <td><input name="WorkSector" type="checkbox" value="Transportation" />Transportation</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Investment" />Investment</td>
                            <td><input name="WorkSector" type="checkbox" value="Education" />Education</td>
                            <td><input name="WorkSector" type="checkbox" value="Energy" />Energy</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSector" type="checkbox" value="Legal" />Legal</td>
                            <td colspan="2"><input name="WorkSector" type="checkbox" value="Others" />Others</td>
                            <td></td>
                        </tr>
                        <tr><td colspan="3"><textarea name="WorkSectorOther" cols="40" rows="3" id="WorkSectorOther" placeholder="If Other Please Specify" spellcheck="true" required></textarea></td></tr>
                    </table>
                        
						
					</select>	
                
				<div>
                
                <div>
					<label for="CurJobRank" accesskey="CJR">Current Job Rank</label>
					<select name="CurJobRank" id="CurJobRank" required="required">
						<option value="N/A"> </option>
                        <option value="Entry-Level">Entry Level</option>
                        <option value="Officer">Officer</option>
                        <option value="Senior">Senior</option>
                        <option value="Manager">Manager </option>
                        <option value="Senior-Manager">Senior Manager</option>
                        <option value="Executive">Executive</option>
                        <option value="Director">Director</option>
                        <option value="CEO">CEO</option>
                        <option value="Owner">Owner</option>
                        <option value="Other">Other</option>
                   	</select>
                    <input name="CurJobRankOther" type="text" id="CurJobRankOther" size="30" placeholder="If Other Please Specify" required  />
				</div>
                
                <div>
					<label for="CurJobTitle" accesskey="CJT">Current Job Title</label>
					<input name="CurJobTitle" type="test" id="CurJobTitle" size="30" placeholder="Your Current Job Title" required  />
				</div>
                
                 <div>
					<label for="CurEMP" accesskey="CE">Current Employer</label>
					<input name="CurEMP" type="test" id="CurEMP" size="30" placeholder="Your Current Company Name" required  />
				</div>
                
                <div>
                	<label for"CurSal" accesskey="CSL">Current or Pervious salary</label>
                    <select name="CurSal"  id="CurSal" required="required">
						<option value="N/A"> </option>
                        <option value="0-100">0-100</option>
                        <option value="100-200">100-200</option>
                        <option value="200-300">200-300</option>
                        <option value="300-400">300-400</option>
                        <option value="400-500">400-500</option>
                        <option value="500-600">500-600</option>
                        <option value="600-700">600-700</option>
                        <option value="700-800">700-800</option>
                        <option value="800-900">800-900</option>
                        <option value="900-1000">900-1000</option>
                        <option value="1000-1100">1000-1100</option>
                        <option value="1100-1200">1100-1200</option>
                        <option value="1200-1300">1200-1300</option>
                        <option value="1300-1400">1300-1400</option>
                        <option value="1400-1500">1400-1500</option>
                        <option value="Other">other</option>
                        </select>
                        <input name="CurSalOther" type="text" id="CurSalOther" placeholder="If Other Please Specify" />
                </div>
                
                <div>
                
					<label for="NoticePeriod" accesskey="NP">Notice Period</label>
					<select name="NoticePeriod" id="NoticePeriod" required="required">
                    	<option value="N/A"> </option>
						<option value="Immediate">Immediate</option>
						<option value="one-month">Less than one month</option>
						<option value="two-months">two months</option>
                        <option value="three-months">three months</option>
					</select>
				</div>
                <div>
					<label for="comments" accesskey="C">Reasons for leaving current employer</label>
					<textarea name="comments" cols="40" rows="3" id="comments" placeholder="What is the reason for leaving the current employer" spellcheck="true" required></textarea>
				</div>

                
                <div>
                
					<label for="subject" accesskey="S">Interested in the field(s) of</label>
					 <table id="checkbox-form">
                    	<tr>
                        	<td ><input name="WorkSectorNew" type="checkbox" value="Agriculture" />Agriculture </td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Logistics" />Logistics</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Financial-Services" />Financial Services</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Accounting-Finance" />Accounting /Finance</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Manufacturing" />Manufacturing</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Food and Beverage" />Food and Beverage</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Advertising" />Advertising</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Media" />Media</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Retail" />Retail</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Airlines/Travel" />Airlines/Travel</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Marketing" />Marketing</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Real-estate" />Real estate</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Automotive" />Automotive</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Music" />Music</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Sales" />Sales</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Banking" />Banking</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Newspapers-Magazines" />Newspapers/Magazines</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Security" />Security</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Customer-Service" />Customer Service</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Pharmaceuticals" />Pharmaceuticals</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Secretarial" />Secretarial</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Construction" />Construction</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Information" />Information</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Sports" />Sports</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Health-Care" />Health Care</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Technology" />Technology</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Telecommunication" />Telecommunication</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Hospitality" />Hospitality</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Consultancy" />Consultancy</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Television" />Television </td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Human-Resources" />Human Resources</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Oil-and-Gas" />Oil and Gas</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Transportation" />Transportation</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Investment" />Investment</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Education" />Education</td>
                            <td><input name="WorkSectorNew" type="checkbox" value="Energy" />Energy</td>
                        </tr>
                        <tr>
                        	<td><input name="WorkSectorNew" type="checkbox" value="Legal" />Legal</td>
                            <td colspan="2"><input name="WorkSectorNew" type="checkbox" value="Others" />Others</td>
                            <td></td>
                        </tr>
                        <tr><td colspan="3"><textarea name="WorkSectorNewOther" cols="40" rows="3" id="WorkSectorNewOther" placeholder="If Other Please Specify" spellcheck="true" required></textarea></td></tr>
                    </table>
				</div>

				

				 
			</fieldset>
            
            <fieldset>

				<legend>Uploading your CV</legend>
				<div>
					<label for="cv" accesskey="CV">Upload your CV</label>
					<input name="cv" type="file" id="cv" style="width:300px;"  required />
				</div>
                <div>
					<label for="perImage" accesskey="PI">Upload your Image <small>(Optional)</small></label>
					<input name="perImage" type="image" id="perImage" style="width:300px;"  required />
				</div>
			</fieldset>

			 
			<input type="submit" class="submit" id="submit" value="Submit" />

		</form>
	</section>
                </div>